IMPLEMENTATION OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) IN EUROPE – SURVEY AFTER ESD EXPERT TRAINING WORKSHOPS 2009 – 2018

T Oyama; N Yahagi; F Berr; T Kiesslich; T Ponchon; T Toyonaga; T Uraoka; A Ziachehabi; F Schachinger; H Seifert; G Kaehler; A Wagner; H Messmann; J Hochberger; SV Kantsevoy; A Mitrakov

doi:10.1055/s-0039-1681476

Endoscopy, Inhaltsverzeichnis

Endoscopy 2019; 51(04): S104
DOI: 10.1055/s-0039-1681476

ESGE Days 2019 oral presentations

Saturday, April 6, 2019 11:00 – 13:00: ESD stomach 2 Club A

Georg Thieme Verlag KG Stuttgart · New York

IMPLEMENTATION OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) IN EUROPE – SURVEY AFTER ESD EXPERT TRAINING WORKSHOPS 2009 – 2018

Autoren

T Oyama

¹Dept of Endoscopy, Central Hospital Advanced Care Center, Saku, Japan
N Yahagi

²Div. of Research & Development for Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
F Berr

³Dept. Medicine I, Paracelsus Medical University Salzburg, Salzburg, Austria
T Kiesslich

³Dept. Medicine I, Paracelsus Medical University Salzburg, Salzburg, Austria

⁴Institute of Physiology, Salzburg, Austria
T Ponchon

⁵Hôpital Edouard Herriot, Lyon, France
T Toyonaga

⁶Dept of Endoscopy, Kobe University Hospital, Kobe, Japan
T Uraoka

⁷Dept of Gastroenterology and Hepatology, Gunma University Hospital, Maebashi, Japan
A Ziachehabi

⁸Ordensklinikum Linz – Elisabethinen, Linz, Austria
F Schachinger

⁹Veterinary Office, Altheim, Austria
H Seifert

¹⁰Dept of Medicine, Gastroenterology, University Hospital, Oldenburg, Germany
G Kaehler

¹¹Endoscopy Div., Dept. of Surgery, Mannheim Campus, University of Heidelberg, Mannheim, Germany
A Wagner

³Dept. Medicine I, Paracelsus Medical University Salzburg, Salzburg, Austria
H Messmann

¹²Klinikum Augsburg, Augsburg, Germany
J Hochberger

¹³Dept of Gastroenterology, Vivantes Klinikum Berlin Friedrichshain, Berlin, Germany
SV Kantsevoy

¹⁴Mercy Medical Center, Univ. of Maryland School of Medicine, Baltimore, United States
A Mitrakov

¹⁵Endoscopy Div., Dept. of Surgery, Nizhniy Novgorod Cancer Hospital, Nizhniy Novgorod, Russian Federation

Abstract

Volltext

Aims:

To obtain information on implementation of ESD in particpating centres of ten experimental ESD Training Workshops in Salzburg [Dig Endosc 2011;23:282 – 89].

Methods:

ESD WORKSHOPs lasted 3.3 days under instruction by international experts, 177 trainees from 135 referral centers had participated once or twice. A brief questionaire was mailed to participants of all 135 centres and reported data (n, %) analyzed.

Results:

Completed data from 77 of 135 centers (57%), information on zero ESD from 32 (24%), no information from 26 (19%). ESD had been implemented without supervision by expert during initial learning. Nineteen (17%) of 109 centres had performed > 150 ESD (professional level), 27 (25%) had 31 – 150 ESD (competent level), and 32 (29%) each had ≤30 ESD (initial learning) and zero ESD, resp.. Outcome (% as median, range) of centres on initial learning (n = 425 ESD) is compared to centers with > 30 ESD (n = 5439): ESD en-bloc was 75 [40 – 80]% vs. 85 [49 – 100]%, conversion to hybrid-ESD 20 [0 – 100]% vs. 11 [0 – 51]% and to piecemeal-EMR 5 [0 – 45]% vs. 4 [0 – 15]%. Majority (65 – 70%) of ESD were in colorectum (35% malignant lesions) with low risk and satisfactory oncological outcome – even during initial learning (s. table). Overall, 30 day morbidity was 0.6 ± 2.2% (stenoses), and mortality 0.04% (2 cases).

Tab. 1:

Outcome of implementation of ESD (median, [range])
Percent ESD-ITT	Colorectal ESD	Emergency surgery	Onco-surgery	CA recurrence
Initial ESD (≤30)	65	0 (mean 1.3)	4	0 (mean 0.9)
(31 centres)	[0 – 100]	[0 – 11]	[0 – 25]	[0 – 10]
Competent ESD (> 30	70	0.9 (mean 1.6)	5	0
(46 centres)	[0 – 92]	[0 – 10]	[0 – 18]	[0 – 0.1]

Conclusions:

ESD has been implemented at least in 46 centres across Europe on competent or professional level, with low risk during unsupervised learning. The majority (65 – 70%) are colorectal ESD, even during initial learning.